Med Clin North Am. May;(3) doi: / Management of Hyperglycemic Crises: Diabetic Ketoacidosis and. For the diagnosis of ketoacidosis, the ADA guidelines recommend that .. Hyperglycemic crises in adult patients with diabetes. Diabetes. Introduction. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nal crisis, trauma and, possibly, continuous subcutaneous insulin infusion (CSII).

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This particular emphasis allows for safer triage of patients presenting to the emergency room to either the intensive care units or step-down units.

Hyperglycemic Crises in Adult Patients With Diabetes

For example, DKA patients with concomitant fever or sepsis may have additional respiratory alkalosis manifesting wda lower than expected PCO2. If desirable glucose reduction is not achieved in the first hour, an additional insulin bolus at 0.

Finally, patients with diabetes insipidus presenting with severe polyuria and dehydration, who are subsequently treated with free water in a form of intravenous dextrose water, can have hyperglycemia- a clinical picture that can be confused with HHS 98 Table 5. Role of glucagon and other hormones in development of diabetic ketoacidosis.

Caution needs to be taken with patients who complain of abdominal pain on presentation because the symptoms could be either hyperlycemic result of hyperflycemic DKA or an indication of a precipitating cause of DKA, particularly in younger patients or in the absence of severe metabolic acidosis 34 Uncontrolled diabetes mellitus in adults: Open in a separate window.

Many cases of DKA and HHS can be prevented by better access to medical care, proper patient ads, and effective communication with a health care provider during an intercurrent illness. Venous pH should be assessed every 2 hours until the pH rises to 7. The use of 0.


The mainstay in the treatment of DKA involves the administration of hypergycemic insulin via ads intravenous infusion or by frequent subcutaneous hyperylycemic intramuscular injections 456 A recent study 2 reported that the cost burden resulting from avoidable hospitalizations due to short-term uncontrolled diabetes including DKA is substantial 2.

Immunogenetic analysis suggest different pathogenesis between obese and lean African-Americans with diabetic hyperglycejic. The initial laboratory evaluation of patients include determination of plasma glucose, blood urea nitrogen, creatinine, electrolytes with calculated anion gaposmolality, serum and urinary ketones, and urinalysis, as well as initial arterial blood gases and a complete blood count with a differential.

However, our study in children demonstrated the effectiveness of intravenous injection of insulin without a bolus dose The rate of adjustment of IV insulin differs as well. The latter provides a carbon skeleton for gluconeogenesis, while the former serves as a substrate for the formation of ketone bodies 28 MilesMD, 3 and Joseph N.

In cases when the serum glucose concentration improves to a greater extent than the serum sodium concentration rises, serum effective osmolality will decrease and may precipitate brain edema C-peptide blood levels in keto-acidosis and in hyperosmolar non-ketotic diabetic coma.

Efficacy of low-dose insulin therapy for severely obtunded patients in diabetic ketoacidosis.

Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.

Inequalities in glycaemic control, hypoglycaemia and diabetic ketoacidosis according to socio-economic status and area-level deprivation in Type 1 diabetes mellitus: The main emphasis in the management of HHS is effective volume repletion and normalization of serum osmolality.


There are also case reports of patients with DKA as the primary manifestation of acromegaly Decompensated diabetes imposes a heavy burden in terms of economics and patient outcomes. The levels of these factors return to normal after insulin therapy and correction of hyperglycemia Diabetes Res Clin Pract. Glucose and ketone body kinetics in diabetic ketoacidosis. Bicarbonate therapy The use of bicarbonate in DKA is controversial 62 because most experts believe that during the treatment, as ketone bodies decrease there will be adequate bicarbonate except in severely acidotic patients.

Phosphate concentration decreases with insulin therapy.

Predisposing factors hylerglycemic the diabetic hyperosmolar state. Hyperosmolar nature of diabetic coma. Diabetic ketoacidosis in infants, children, and adolescents: Acromegaly presenting with diabetic ketoacidosis. This could be due to a combination of factors, including exogenous insulin injection en route to the hospital, antecedent food restriction 3940and inhibition of gluconeogenesis.

Severe hypothermia, if present, is a poor prognostic sign Thirty years of personal experience in hyperglycemic crises: Bicarbonate therapy in severe diabetic ketoacidosis. Arch Iranian Med ; 8: Nine small studies in a total of patients with diabetic ketoacidosis treated with bicarbonate and patients without alkali therapy [ 62 ] support the notion that bicarbonate therapy for DKA offers no advantage in improving cardiac or neurologic functions or in the rate of recovery of hyperglycemia and ketoacidosis.